Pulse Oximetry

[Mesa Fyr]

How does everyone feel about pulse ox's in the field for prehospital care? How do you use them on specific patients and how does it affect your treatment? What are the protocols for it's use wherever you may be??
I have a longstanding debate on their use with some that I work with in that I put the patient on hi-flow 02 when thier condition calls for it without getting a baseline pulse ox reading. ie: Chest pain - In my opinion, that line about 'time is muscle' is dead on and I won't delay getting them oxygen. There are many out there who think that as long as they are at 96-99% on the pulse ox, the most they need is a cannula, regardless of other symptoms. I think those that share that thought are wrong. I do think it has a place in evaluating your treatment efforts in other patients, like asthmatics or COPD'ers, to see if they are responsive to your interventions.

Any thoughts???

Be safe...

[This message has been edited by Mesa Fyr (edited February 19, 2000).]

[Boothby]

We are just making the transition to pulse ox here, as we get our new LP 12s. I believe that before you use a pulse ox you must be able to recognize a hypoxic patient by looking at them. Pulse oximetry is a wonderfull tool, but it doesn't replace your eyes, ears, hands, and brains! As always treat the patient not the monitor. Pulse ox's are not always an accurate assesment of the patients pulmonary function. If the patient needs O2 give it to them regardless of what the pulse ox says! And as far as high flow O2 I'm with you. If the patient is showing S/S of MI they get high flow O2. If they are SOB they get high flow O2. If a patient presented with MI S/S you wouldn't withhold treatment because the 12 lead didn't show ST changes. We all know that the 12 lead is not the end all. It's the same way with the pulse ox. If the patient is SOB but the pulse ox says 98% you had better put them on high flow O2. The only real difinative measure of O2 carried in the blood is ABGs and we don't do that in the field. If these guys are still hassling you challenge them to work without a pulse ox. Most of these new breed medics don't know how and will fold up without their pulse ox.

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Larry Boothby
Firefighter/Paramedic
Truck 3 A-shift
Local 1784
Memphis.

[Paramark14]

I agree with boothby. SaO2 is a good tool, but you have to tx the S/S. You have to consider other things like cold extremities, nail polish, etc. It reads bad gas as well as good. A pts. hgb can be saturated with CO but have a SaO2 of 99%.


Mark

NREMTP

Indiana

[Steamer]

Pulse oximetry is just a tool like anything else we use. In the case of a possible AMI, the pulse ox may show a 98% sat, but you should still treat with the high concentration O2. The only thing the the machine is telling you for sure is the "indicated" O2 concentration of the blood in the finger; and that can definitely be altered by the factors that Paramark14 listed in his post.
Be more concerned with the signs and symptoms your patient exhibits.The bottom line is don't treat the machine; treat your patient.

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Steve Gallagher
Chillicothe (Ohio) Fire Department

[benson911]

I like the pulse ox as one of our many tools to assess a patient. Use 'em all, I say.

The best thing a pulse ox does is tell me if my O2 therapy is working or not. Put it on early, it takes no time at all, and see if that high flow O2 made a difference. If it didn't, you need to do something else - try a breathing treatment, bag 'em, or tube 'em.

It's a good tool - you just need to know it's limitations. Don't treat the pulse ox - treat the patient.

[FIREMEDIC BILL]

I have found that a pulseox is a valuable tool to communicate pt. info. For example, when calling in a patient report to the receiving ER I can relay low sats to the MD on duty in the ER, therefore better preparing the ER for a hypoxic pt. But at the same time I always treat my pt. and not the sat% of a patient.

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FIREMEDIC BILLBO RESCUE 8
GWINNETT FIRE/GRAYSON GA.

[9m18]

I agree with what I've read so far. But I think the key is to treat the patient, not the machine. It's a good tool, but for example, the pulse ox machine registers bound hemoglobin. It does not measure or differentiate what the hemoglobin is bound to. In other words, a pt presenting with all the symptoms of CO poisoning might show a pulse ox of 99%. But the machine is measuring hemoglobin bound to CO, not O2. The pt's actual level of o2 in the blood may be less than 50%. If the pt presents with all the signs and symptoms, treat the patient!

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[Mesa Fyr]

Well, thanks for all the feedback.. Just confirms what I believe in...Treating the patient as best as possible..



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Be Safe...

[Resq14]

I think it's important to remember that our pulse oximeters are only indicating the oxygenation of the red blood cells (percentage-wise) swimming around in our patient. Therefore, if your patient is anemic, or has lost some blood and is hypovolemic, the saturation level can still be very high, if not normal.

But do you think the patient is perfusing ok?

The best analogy to describe this that I've heard is goes something like:

"Say I promise to give you all the money in my wallet. Or maybe 95% of the money in my wallet. Whadda ya think? Sound like a good deal? Well if I only have 3 cents, 95% of 3 cents isn't all that great, now is it?"

I agree completely to never withold oxygen from someone based solely on their oximeter readings. Remember that high concentrations of oxygen encourage it to diffuse into the blood stream, so that even non-hemoglobinated transport of oxygen to cells is possible. The oximeter is only telling you a small part of the whole story.

[capt3211]

Pulse Ox would be nice item to have and I also agree with 9m18 "treat the patient not the machine".